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Palliative cancer care - pain - Management
How should I assess pain severity?

  • Use a validated structured pain assessment tool, for example:
    • Numerical rating scale — mark on a scale of 0 (no pain) to 10 (worst possible pain) how strong the pain is.
    • Visual analogue scale — mark on a 10-cm line (with 'no pain' at one end and 'worst possible pain' at the other end) how strong the pain is.
    • The score can be correlated to the severity of the pain:
      • Mild pain: less than 3 out of 10 on a visual analogue scale or numerical rating scale.
      • Mild to moderate pain: 3–6 out of 10 on a visual analogue scale or numerical rating scale.
      • Severe pain: more than 6 out of 10 on a visual analogue scale or numerical rating scale.
  • Differentiate between the person's usual level of pain, breakthrough pain, incident pain, and 'end of dose' failure of regular around-the-clock analgesia. End of dose failure usually occurs at the same time each day, usually just before the next dose is due.
Basis for recommendation
  • These recommendations are based on expert opinion.
  • To assess the response to treatment, it is useful to have some measure of the severity of pain before and after an intervention [Abu-Saad and Courtens, 2001]. Pain rating scales may be useful to assess the course of a person's pain, assess the effects of treatment, and reassure the person that their pain is being thoroughly addressed [IAHPC, 2004]:
    • A guideline on the control of pain in adults with cancer from the Scottish Intercollegiate Guidelines Network (SIGN) recommends that people with cancer pain should have treatment outcomes monitored regularly using visual analogue scales, numerical rating scales, or verbal rating scales [SIGN, 2008]. This recommendation was based on expert opinion and non-analytic studies.
    • There is no universally accepted tool for the assessment of cancer pain. Standardized pain assessment tools that have been recommended by the European Association of Palliative Care for use in research and clinical practice include visual analogue scales, numerical rating scales, and verbal rating scales [Caraceni et al, 2002]. These are also valid tools for measuring pain in very elderly or cognitively impaired people, and those who are dying [SIGN, 2008].
    • CKS has adopted the classifications of severity of pain given (on the basis of expert opinion) in the SIGN guideline [SIGN, 2008]. However, it is acknowledged that these definitions are subjective, and clinical judgement is therefore needed.

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